DUP218 Health Care Consumer FINAL

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2012 Survey o U.S.Health Care Consumers:Five-Year Look BackKey fndings, strategic implications

A Dlitt Ct Halth Sltis pt


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Foreword

1. Bureau o Economic Analysis. Gross Domestic Product: First Quarter 2012 (Advance Estimate). April 27, 2012.2. Bureau o Economic Analysis http://www.bea.gov, accessed April 20123. Each sample o up to 4,000 U.S. adults has been demographically representative o the U.S. population with respect to

age, gender, income, race/ethnicity, and geography.

ConSumerS are the oundation o the United States economy: 70 percent o our GrossDomestic Product (GDP) is dependent upon personal consumption;1 their needs and wantsdrive innovation in every domain o daily lie except, perhaps, health care.

Recently, health policy experts and economists have challenged the health care industrys

approach to consumerism; many reason that costs would be lower, service better, and quality sub-

stantially improved i the industry repositioned itsel as a consumer market. Among consumers,

there is a widening gap between their unmet needs and the systems perormance. Still, many stake-

holders doubt that the health care industry could unction in a consumer economy, reasoning thathealth care can be too complicated or the average Joe to engage with it knowledgeably and appro-

priately. Consumers decisions to purchase or utilize health care services and products oen rely

upon expert recommendations rom medical proessionals. In addition, many consumers choices

are aected by health insurance, which can distort the true cost o health care services and products.

Increasingly, consumers are bearing the costs o health care; expenditures or personal consump-

tion o health care are the second-highest household expense aer housing/utilities.2 Although the

idiosyncrasies o the health care system are likely to characterize the market or a long time to come,

there are signs that consumers are ready to become more active, inormed decision-makers.

2012 marks the h year or the Deloitte Center or Health Solutions survey o U.S. adult health

care consumers about their interest in and ability to operate in a consumer health care market.3

Tese annual online surveys have queried up to 4,000 adults per year in various age, health status,

income, and insurance groups to identiy the degree to which consumers are prepared to engage

with the health care system. Five years ago, ndings rom Deloittes rst consumer survey (2008)

revealed that users o the health care system are neither patient nor patients. Tey are consum-

ers, and this remains true in 2012. Te distinctions between the two are stark; the implications are

transormativenot only to the health care industry but to every U.S. household, company, and

government agency.

Tis report provides data-driven insights gleaned rom the Deloitte 2012 Survey of U.S. Health

Care Consumers as well as a look back at ve years o ndings that point to untapped potential or

increased health care industry engagement with consumers and, with that, new challenges and

opportunities or providers, health plans, employers, and government.

Pal H. Kckly, PhDexctiv DictDlitt Ct Halth SltisWashigt, D.C.

2012 Survey of U.S. Health Care Consumers: Five-Year Look Back

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Conducted annually since 2008, Deloittes

longitudinal study o heath care consum-

ers seeks to provide a comprehensive view

o health care consumerism, a view that goes

beyond the conventional boundaries o what

health and health care are commonly thoughtto encompass.

In addition to the traditional services that

doctors and hospitals provide, the studys

ramework takes into account the expanding

spectrum o treatment alternatives, delivery

settings, inormation sources, and programs

that are coming into existence to promote well-

ness and sel-care, address health needs, and

nance health care.

Now in its h year, the 2012 survey con-

tinues to build on previous years surveys by

exploring consumers behaviors, attitudes, and

unmet needs in six domains (gure 1):

Wellness and healthy living

Inormation resources

raditional health services

Alternative health services

Health insurance

Health policy

Introduction

Health care consumerism: Conceptual ramework or this study

Wellness

andhealthy

living

Alternative

health

services

Informationresources

Traditional

health

services

Healthpolicy

Health

insurance

Figure 1: Zones o health care consumer activity


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Since 2008, the Deloitte Center or Health

Solutions has annually polled a nationally rep-

resentative sample o the U.S. adult population

(up to 4,000 U.S. consumers) about their expe-

riences and attitudes related to six domains.

Tese online surveys have queried adults in

varied health status, income, and insurance

cohorts to gauge the degree to which individu-als are engaging with the health care system as

patients or consumers.

In February 2012, a nationally represen-

tative sample o 4,012 U.S. adults, aged 18

and older, was surveyed, using a web-based

questionnaire. Te sampling rame was based

upon quotas reective o the 2010 U.S.Census

to ensure proportional representation o the

nations adult population with respect to age,

gender, race/ethnicity, income, geography,insurance status (insured or uninsured), and

primary insurance source (employer, direct

purchase, Medicare, Medicaid, and other).4

Tis marks a change rom 20082011, when

ewer quotas were used and supplemented

by cell weighting to achieve a representative

sample. In those earlier years, the survey

results were weighted with respect to basic

demographics (age, gender, race/ethnicity, and

income), but not additional variables such as

insurance status and source. o achieve even

closer sample alignment with insurance status

and source distributions in the U.S. popula-

tion, a more extensive set o quotas was used

in 2012 and additional weighting was not

necessary to achieve a representative sample.

Dierences reported in insurance status and

source between 20082011 and 2012 are due

largely to this adjustment in sampling.

Te margin o error is +/- 1.6 percent at

the .95 condence level. Te online survey

consisted o 65 questions addressing specic

behaviors and attitudes, with 39 potential

ollow-up questions and an additional 20 ques-

tions asking about demographic and health-

related characteristics. English and Spanish

versions were available. Participants were asked

about behaviors beore attitudes within each

topic area to reduce response bias.2012 brings a ve-year milestone in the

consumer survey (gure 2) and, where pos-

sible, comparisons are made to the surveys

conducted in 2008, 2009, 2010, and 2011.

Dierences in question wording and response

scalesused in an eort to improve the survey

instrumentpreclude direct comparison in

some cases. Core questions rom the previ-

ous years are repeated periodically to assess

how health care consumerism is evolvingin the United States. Data presented in this

report will note i a question was not asked

in a specic year and all data reers to the

2012 consumer survey unless specically

stated otherwise.

Pspctiv: Th u.S. halth ca syst

In 2010, health care consumed 17.9

percent o the U.S. GDP, or $2.6 trillion in

health care expenditures.5 As widely noted,

the United States consistently spends more

on health care per capita than do all other

developed countries.6 Health care costs hover

around $8,500 per capita7 and are expected to

increase at an average annual growth rate o

5.8 percent or the next decade.8 Tis annual

growth is anticipated to exceed that o the

economy by 1.1 percentage points; by 2020,

national health spending is expected to reach

19.8 percent o GDP, at $4.6 trillion in health

care expenditures.9

Survey methodology


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4. Quotas or insurance status and insurance source distributions were based on KCMU/Urban Institute analysis o the 2011ASEC Supplement to the CPS, presented in slides published by the Kaiser Family Foundation http://slides.k.org

5. Centers or Medicare & Medicaid Services, NHE Tables 2010. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/tables.pd. Accessed April, 2012.

6. Davis. K., C. Schoen, and K. Sremikis. Mirror, Mirror On the Wall: How the Perormance o the U.S. Health Care SystemCompares Internationally: 2010 Update. Washington, DC: The Commonwealth Fund, 2010. Wyss. D., N.G. Swann andM. Mrsnik. Global Aging 2010: In the U.S., Going Gray will Cost a Lot More Green. Standard & Poors, October 25, 2010.

7. Centers or Medicare & Medicaid Services, NHE Tables 2010. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/tables.pd. Accessed April, 2012.

8. Centers or Medicare & Medicaid Services. National Health Expenditure Projections 2010-2020 https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads//proj2010.pd.Accessed April, 2012.

9. Ibid.10. The Impact of Health Reform on Health Insurance Coverage: Projection Scenarios over 10 Years, Deloitte Center or

Health Solutions. September 2011. www.deloitte.com/us/coveragemodel.11. The Hidden Costs of U.S. Health Care, Deloitte Center or Health Solutions and Deloitte Center or Financial Solutions.

March 2011. Analysis based upon projected 2009 data.

Figure 2: Total respondents: 20082012

2008 2009 2010 2011 2012

3,031 4,001 4,008 4,000 4,012

An estimated 32 million currently unin-

sured individuals will be required to hold a

minimum level o health insurance begin-

ning January 1, 2014, a direct outcome o the

Aordable Care Act (ACA). Implementation o

the provisions o the ACA as it currently stands

are in the near term (commencing 2013) and

are to some extent subject to how the broadereconomic and political environments play out.

Nonetheless, the Deloitte model, Te Impact of

Health Reform on Health Insurance Coverage:

Projection Scenarios Over 10 Years,10 assesses

the eects o key economic, behavioral, politi-

cal, and strategic variables on insurance cover-

age under the ACA, and produces a 10-year

annual projection o market conguration in

terms o number o insured and uninsured

providing considerable insights into how thehealth care system may change based upon

courses o action that may be undertaken

by states, employers, and ultimately health

care consumers.

Te costs o health care are unsustainable.

In 2011, Deloitte estimated that spending on

health care outside o the National Health

Expenditure Accounts (NHEA) or such

items as supervisory care or others, comple-

mentary and alternative medicine, vitamins,

supplements, and nutritional products would

account or an additional $363 billion or

14.7 percent more than that reported in the

NHEA accounts.11

Subject to any uture potential revisions,the ACA o 2010 proposes numerous ways

to potentially extract greater value rom and

improve the quality o the U.S. health care

system. Provisions o the act include a require-

ment that most individuals have health insur-

ance and delivery system reorms that change

the payment and service delivery systems.

Challenged in the courts, on June 28, 2012,

the Supreme Court o the United States in its

rulings on the our legal challenges to the ACAprovided a measure o certainty when it upheld

the acts constitutionality. But ongoing eorts

in Congress to repeal and replace the law could

create new challenges over the long term.

Meanwhile, the Internal Revenue Service and

other agencies are in the process o developing

regulations to implement the law as enacted.


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racking health care consumerism over

ve years 20082012, a period that saw major

upheavals in the broader economy, reveals

slow and incremental changes in how consum-

ers attitudes and behaviors intersect with thehealth care system.

Favorable views o overall system peror-

mance appear to be increasing and yet the

system is considered to

be conusing, complex,

and costly. Perceptions

o wasted spending and

the cost o the health care

system continue to be

unavorable. Condenceabout eeling prepared

to deal with uture

health care expenses has

declined over the ve

yearsseniors eel more

condent than younger

generations, but their con-

dence is slipping as well.

Furthermore, the cost o

care leads many to delay

or decide not to seek care,

and, or some, to seek

better value or cheaper

alternatives by switching

health plans, health care

providers or treatment

approaches, or oregoing

the purchase o insurance.

Satisaction with

elements o the health

care system varies with

consumers consistently being satised with

primary care services, less so or hospital care

and or health plans. Utilization o the system

is constant or seeking care rom a primary

care practitioner, although a decline in well-ness/screening visits is noted; use o alternative

therapies is low and constant. A recent increase

in the use o the emergency room is also seen.

Highlights 20082012

Consumer engagement with the healthcare system is a work in progress

2012: 34%2011: 22%2010: 24%2009: 20%

% who givethe overallperformance

of the system afavorablereport cardgrade(A or B)

% who givethe overallperformanceof the system a

unfavorable

report cardgrade(D or F)

% who believethat 50% ormore ofhealth care

spendingis wasted

2012: 24%2011: 37%

2010: 35%2009: 37%

2012: 62%2011: 51%2010: 49%2009: 51%

Health care system performance

A/B

D/F

$


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Ky isss css a

accss, cst, ad val.

As health care consumerism grows, con-

sumers are interested in more and better

choices: in customizable health plans, in ser-

vices such as retail clinics and non-physician

primary care providers such as pharmacists,

nurse practitioners, and physician assistants.

Interest is shown in online tools that provide

inormation on potential cost o care and

insurance, quality, and perormance inorma-

tion on both physicians and hospitals.

Many use online resources or inormation

about treatments and medical conditions and

growing numbers (younger generations in

particular) look or technology-based solutions

such as monitoring devices, apps, and inorma-

tion rom social media.

*Chag btw yas is st likly d t a chag i thdlgy i th 2012 svy wh th saplig a was difd talig clsly with th ct u.S. distibti. r t thdlgy dtail.


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Six segments o the health

care consumer marketThe health care consumer market is not homogenousDeloitte identifed six unique consumer segmentsthat navigate the system in very distinctive ways. Patterns in attitudes and behaviorsnot demographics

and socioeconomic characteristicsdefne these segments. Over the past fve years, the most disengaged

segment (Casual & Cautious) and one o the most active segments (Online & Onboard) have grown.

Figure 3: Health Care Consumer Segments

Six Unique Health Care Consumer Segments 2008 2012 Change

Casual &Cautious

Currently disengaged with the lowest rates o prevention (ewer well visits, lowerparticipation and interest in wellness programs, low vitamin use), use o the system,

and compliance with treatment when treatment is neededLess likely than other segments to have health insurance, least prepared fnancially to

handle uture health care costs, and least satisfed with their health plan i insured

Low interest in shopping or insurance on own and customizing health plan

23% 34% + 11%

Content &Compliant

Most satisfed with their primary care provider and health plan

Follow passive patient approachrely on doctors to make decisions, ollowthrough on recommended treatment, adhere strictly to medication labels

Preer traditional doctors, standard treatments, and conventional care settings

Most trusting o doctors, least trusting o online sources, or inormation

Least interested in shopping or insurance on own and customizing health plan

26% 22% - 4%

Online &Onboard

High use o the system and medications

Most likely to use health plan and provider websites, sel-monitoring tools, andelectronic personal health records

Highest use o quality and price inormation to compare providers and interested incustomizing health plan (average interest in shopping on own)

Preer traditional doctors and standard treatment approaches, but open to receivingcare in non-conventional settings like retail clinics

15% 17% + 2%

Sick &Savvy

Highest use o the system and medications

Most proactive, preventive, prepared

Seek inormation to compare providers and identiy treatment options, partner withdoctors in making decisions, adhere to treatment plan

Most likely to buy prescription medications online or through mail order

Average interest in shopping on own or insurance and customizing health plan

21% 14% - 7%

Out &About

Preer providers who use alternative treatment approaches and most likely to use andsubstitute alternative/natural therapies or prescribed medication

Look online or inormation and seek guidance rom experts, but tend to makedecisions independently and adhere less strictly to recommended plan

Least satisfed with their primary care provider, more likely to switch doctors

More likely to travel outside area or U.S. or care

Interested in shopping on own or insurance and customizing health plan

11% 9% -2

Shop &Save

Most likely to switch health plans, providers, and medications

Most likely to seek care at retail clinics and travel out o area or U.S. or care

More likely to buy prescription medications online or through mail order

Interested in comparing plans, providers, and treatments on price/quality

Most interested in shopping on own or insurance and customizing health plan

Preer traditional doctors and standard treatment approaches, but open to usingalternative/natural therapies; does not always adhere to treatment plan

4% 4% 0%


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Satisaction is low in 2012 (22 percent), but

it may be improving (up rom 16 percent in

the previous year) (not shown).

Consumers views o overall health care

system perormance may be improving

1 in 3 gives it a avorable report card grade

o A or B in 2012 compared to 1 in 5

our years ago (gure 4).

In contrast, in 2012, 39 percent give the U.S.

health care system an average report card

Views on U.S. health care

system perormanceConsumers relate to health care on a deeply personal basis.Their understanding o the health care system is basedalmost exclusively on their personal experiences. As a result,they hold strong opinions about its perormance.

0%

10%

20%

30%

40%

50%

A

2%

Data are rounded

2009

2010

2011

2012

In 2012, 3% say dont know/uncertain (not shown)

4%3%

8%

18%

Report card grade of A, B, C, D, and F where A is excellent and F is failing

20% 19%

26%

43%41% 42%

39%

25%23%

24%

16%

13%12% 12%

8%

B C D F

Figure 4: Using a typical report card scale with grades o A, B, C, D, and F, how would you grade the

overall perormance o the U.S. health care system?


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61%: Having the newest innovations in treatments, services, andmedical technologies

56%: Up-to-date information technology

52%:Meeting the healthcare needs of me and my family

19%:Meeting the healthcare needs of the uninsured

54%:Meeting thehealth care needs

of the insured

25%: Getting the bestvalue for money spent

Figure 5: Using a typical report card scale with grades o A, B, C, D, and F, how would you grade the

U.S. health care system on the ollowing dimensions?

Gadig syst lts avabl (A B) sig a typical pt cad scal with gads A, B, C, D, ad F

grade o C, or a ailing grade o D (16

percent) or F (8 percent). Tis nding

is somewhat lower than in previous years,

with 36 percent grading the system una-

vorably in 2011, 35 percent in 2010, and 37

percent in 2009 (gure 4).

Te system gets high marks or clinical

innovation (61 percent give it an A or a

B) and use o technology (56 percent give

it an A or a B) (gure 5).

Fewer consumers give the system high

marks or value and responding to the

needs o the uninsured (gure 5).

Te system is considered to ail (rating

perormance as a D or F) those without

insurance (53 percent) and to oer poor

value or money spent on health care (44

percent) (not shown).

In 2012, only 25 percent eel that the best

value is obtained or the money spent

(gure 5).

Increasing perceptions o waste and lack o

value may be contributing to dissatisaction

with the system; in 2012, 62 percent believe

that 50 percent or more o the dollars spent

on health care are wastedup rom 51

percent in 2009, 49 percent in 2010, and 51

percent in 2011 (not shown).


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In 2012, causes o waste were considered

to be raud and abuse in payment systems

(69 percent), consumer behavior such as

unhealthy liestyles (49 percent), and dupli-

cation o tests and procedures (38 percent)(gure 6).

Impact o unavorableeconomic conditions andrising health care costs

Th cst halth ca, cpld with

th stat th cy, is cc

t css, pptig ay talt hshld spdig, dlay

ca, ad wy abt thi ability

t pay t halth ca csts.

2 o 3 consumers say the recent economic

slowdown has caused them to be more

cautious or to cut back on what they spend

on health care products and services, a drop

rom the 3 in 4 who said they were cautious

with health care spending in 2011

(gure 7).

However, there was a slight increase

between 2011 and 2012 (rising rom 13

percent to 15 percent) o those who say

the economic conditions have had a highly

signicant impact on household health care

spending (gure 7).

In 2012, around 2 in 5 say the proportion

o total annual household income spent on

health care stayed about the same as the

previous year (gure 8).

Around 3 in 10 say their spending increased

and 2 in 10 say spending decreased

(gure 8).

0% 10% 20% 30% 40% 50% 60% 70% 80%

69%Fraud and abusein the payment/

reimbursement system

Main causes of

waste (2012)

Individuals not takingresponsibility for their own

health/lead unhealthy lifestyles

Duplication of tests and procedures

because physicians dont share

patient health information

Unecessary paperwork

Doctors provide more services thannecessary/refuse to treat high risk

patients to avoid possibly being sued

Over-regulation of thehealth care industry

Taking extreme measures to extend life

when there is little hope of recovering/returning to a meaningful life

Doctors performing tests/procedures

outside evidence-based guidelines

49%

38%

34%

34%

30%

20%

18%

Figure 6: Which o the ollowing do you think cause the most money to be wasted?


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No

impact

Slight

impact

Significant

impact

Highly

significantimpact

Not sure Any

impact

30%

25%

32%

41%

19%20%

15%13%

4%

2011

2012

Not an

option

in 2011

66%

75%

Figure 7: What impact has the recent economic slowdown had on your households health care

spending?

30% 43% 23% 3%

Increased

21% 33% 41% 5%

23% 33% 38% 6%

33% 37% 28% 2%

30% 45% 24% 1%

37% 40% 21% 2%

34% 46% 19% 1%

Total sample

Uninsured

Not working/looking for work

Self employed

Employed by organization

Have chronic disease

Insured

Stayed about the same Decreased Not sure

Figure 8: Would you say that the proportion o your total household consumption spent on health care

has increased, decreased, or stayed about the same when compared to the previous 12 months?


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Te proportion o household expenditures

directed toward health care in the past year

decreased among considerably more o the

uninsured and unemployed than among

other consumers (gure 8).

Tere is a decline across all generations

between 2011 and 2012 in consumer con-

dence about eeling prepared to handle

uture health care costs (gure 9).

O all the generations, Seniors eel the most

secure nancially; however, only 1 in 3

Seniors are condent about dealing with

uture health care costs (gure 9).

Over the years, very ew o those without

insurance say they eel prepared to meet

uture health care costs.

Between 2011 and 2012, the insured report

a decreasing sense o condence in meeting

uture health care costs (26 percent in 2011

and 20 percent in 2012) (gure 9).

In 2012, 1 in 4 consumers (27 percent) (1

in 3 (34 percent) among the uninsured) saythey decided not to see a doctor when sick

or injured in the last 12 months. 1 in 9 (12

percent) decided to delay or skip treatment

recommended by a doctor.

Among those who didnt seek medical

attention, the percentage citing cost as

the reason decreased between 2011 and

2012 (rom 53 percent to 46 percent) but

remained higher than in 2010 (39 percent)

and 2009 (38 percent). Tose who say

they delayed or skipped treatment or cost

reasons rose rom 52 percent in 2011 to 58

percent in 2012 (not shown), continuing

an upward trend rom previous years (40

percent in 2009, 42 percent in 2010).

60%

2009 2010 2011 2012

40%

20%

0%

42%

33%

20%

16%15%14%12%

5%

29%26%

18%

17%

6%Uninsured

Insured

65+ years

Rating of 8, 9, or 10 on a 10-point scale where 10 is completely preparedData are rounded

5564 years

2544 years

4554 years

1824 years

Figure 9: To what extent do you eel your household is fnancially prepared to handle uture healthcare costs?


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Zone one: Wellness

and healthy livingConsumers augment health care with wellness checks, use ovitamins and healthier ood choices, and some sel-care programsbut overall engagement in wellness and preventive actions is low.


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Most consumers in 2012 believe themselves

to be in good health (84 percent), slightly

ewer than in 2011 (91 percent), but morethan hal (52 percent) have been diag-

nosed with one or more chronic conditions

(similar to 2009, 2010, and 2011). In 2012,

around hal (49 percent) o consumers

with chronic conditions say that these have

little to no impact (between zero and 33

percent impact) on their activities o daily

living (not shown).

2 in 3 (65 percent) say they had a wellness

check-up in the past 12 months, a decrease

rom 2011 (76 percent), 2010 (68 percent),and 2009 (73 percent) (gure 10). Te

uninsured are hal as likely as the insured

to report seeing a doctor or a well visit or

routine check-up (36 percent vs. 72 per-

cent). Tis is similar to previous years

(not shown).

2009 2010 2011 2012

56%

65%

68%

22%19%

73%

100%

80%

60%

40%

20%

0%

44%

37%

10%

43%

25%

76%

Visited doctor for well visit or routine check-up Got a flu shot

Chose a food deliberately for its health benefit Participated in a healthy living/wellness program

Figure 10: Which o the ollowing have you done in the last 12 months?


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Participation in healthy living/wellness pro-

grams oered by employers, health plans,

and other organizations declined between

2011 (25 percent) and 2012 (10 percent)

(gure 10). Both insured and uninsuredconsumers reported lower rates o partici-

pation in 2012 compared to previous years

(not shown).

Use o vitamins, minerals, and herbal

supplements is relatively high. 60 percent

report taking vitamins/minerals (68 percent

in 2011) on a regular basis or health pur-

poses; 18 percent take herbal supplements

(not shown).

44 percent say they deliberately purchased

ood such as probiotic yogurts or choles-

terol-reducing spreads or its perceived

health benets (gure 10).

37 percent o consumers say they received

an inuenza shot during the past year, com-

pared with 43 percent in 2011 (gure 10).

Around hal (49 percent) o consumers who

engage in tobacco use and one-quarter (24

percent) who drink alcohol say they are try-

ing to reduce intake (gure 11).

Used tobacco, including cigarettes, cigars, and othertobacco products.

19%

49%

40%

24%

13%

38%

Of tobacco users: tried to quit smoking/reduce tobacco use

Consumed wine, beer, or alcohol

Of alcohol consumers: tried to reduce the amount of wine,beer, or alcohol consumed

Of alcohol consumers: consumed more wine, beer, or

alcohol than might be healthy

Of alcohol consumers who think they drink too much: triedto reduce the amount of wine, beer, or alcohol consumed

Figure 11: Which o the ollowing, i any, have you done in the last 12 months?


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Incentives and better health

Fw a willig t pay sppts

sch as halth cachs yaly halth

scigs; hal th css a pt ictivs t chag bhavis.

Few consumers are willing to pay or health

coaches (5 percent) or yearly health screen-

ings (8 percent) i they have to pay or the

ull cost o the program (gure 12).

I the program was oered or no out-o-

pocket cost, over one-hal (57 percent) say

they would be willing to use a health coach

and two-thirds (66 percent) would undergo

an annual screening exam (gure 12).

Incentives would motivate around hal o

consumers to use a health coach (48 per-

cent) or complete an annual health screen-

ing (55 percent) (gure 12).

If pay fullcost

Willing to meeta health coach

Rating of 8, 9, or 10 on a 10-point scale where 10 is completely willing.

5%

If no out-of-pocket cost

57%

If financial rewardor incentive offered

48%

Willing to undertake

annual health screening8% 66% 55%

Figure 12: How willing would you be to meet with a health coach/complete yearly health screenings and

ollow through with recommended actions and activities?


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Zone two: Inormation

resourcesMany want access to tools or websites that enable them to gaugequality and cost. Fewer are currently interested in technologiesthat support sel-monitoring and health improvement.

In 2012, 45 percent o consumers report

looking online or inormation about treat-

ment optionssimilar to those who did so

in 2011 (43 percent) but lower than the 55

percent in 2010 and 57 percent in 2009

(not shown).

7 percent say in the past year, they have

searched online or inormation to help

decide which hospital to visit and 10 per-

cent say they looked online or inormation

to help select a health insurance policy

(not shown).

Around hal the consumers say they would

like access to tools or websites that enable

them to estimate the cost o care, evaluate

quality and satisaction with specic pro-

viders and hospitals, and benet rom user

reviews (gure 13).

Interest in using sel-monitoring devices

has decreased rom 2008 to 2012

(gure 14).

In 2012, hal o all consumers say they

would preer to communicate with theirdoctor in person or by phone instead o

using a sel-monitoring device (gure 14).

Tool telling how much a health plan would pay forcertain treatments or services before use

Rating of 8, 9, or 10 on a 10-point scale where 10 is extremely likely.

53%

Quality rankings, satisfaction ratings, and patientreviews for specific doctors and hospitals 52%

Effectiveness ratings, safety information, and userreviews for specific health care products, medications,and medical devices

49%

Pricing tool that could help to compare and negotiatehealth care prices with specific doctors and hospitals 44%

Figure 13: How likely would you be to use websites that oer the ollowing?


19


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56 percent say they would be willing to use

videoconerencing or sick visits; 67 percent

would do so or ollow-up visits

(not shown).

Around 4 in 10 consumers say they are

interested in using apps that provide medi-

cation reminders, and that help set and

track health improvement goals

(not shown).

Although the number o people who keep a

personal health record (PHR) o some kind

has nearly doubled over the past ve years

(25 percent in 2008 to 46 percent in 2012),

ew maintain an electronic personal record

(gure 15).

35 percent overall say they are concerned

about privacy and security o personalinormation i they were to use an elec-

tronic health record (gure 15).

Preerred channels to receive health inor-

mation (e.g., treatment plans, reminders)

vary, with older generations preerring

telephone- and paper-based approaches;

younger generations preer emails, phone

calls, and text messages (gure 16).

*Rating of 8, 9, or 10 on a 10-point scale where 10 is extremely interested (not asked in 2010)

2008

2009

2011

2012

Prefer to communicate with doctor byphone or in person

Reasons for not being interested in using a self-monitoring tool/device (2012)

Interest in using a self-monitoring tool/device, by year

Does not have a smartphone or tablet

Privacy and security of informationmight be at risk

That kind service would probably costtoo much

72%

68%

61%

41%

50%

43%

31%

23%

Figure 14: I you developed an ongoing health condition that needed to be checked or treated regu-

larly, how interested would you be in using the ollowing tools or supports on a regular basis i thetechnology became available to you?


20


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Seniors

(1900-1945)

32%33%

39%

46%

34%36%

30%30%

2008

10%

14%

9%

6%

9%7%

13%

7%

Boomers

(1946-1964)

Gen X

(1965-1981)

Millennials

(1982-1994)

Seniors

(1900-1945)

Boomers

(1946-1964)

Gen X

(1965-1981)

Millennials

(1982-1994)

NOTE: Question about concern was not asked in 2008

2009 2010 2011 2012

10% overall currently maintain a personalcomputer- or web-based health record

Use is steadily rising among Millennials

35% overall are concerned about privacy and securityof personal information if they were to use an

electronic PHR

Concern is lowest among Millennials, highest amongBoomers (but their concern appears to be declining)

Figure 15: Do you currently maintain a paper-based and/or electronic-based personal health/medical

record? / How concerned are you that the privacy and security o your personal health/medical inor-mation might be at risk i you were to use a computer sotware program or website to maintain a

personal health record that allowed you to share inormation with your doctor through an Internet

connection?

E-mail alerts

Personalphone calls

Letters or postcardsthrough regular mail

Text messages

Paper copy of personal health

action plan and/or follow-up

instructions after visit

Link to website to download

personal health action plan and/or

follow-up instructions after visit

Rating of 8, 9, or 10 on a 10-point scale where 10 is extremely interested.

43% 41% 45% 44% 43%

34% 31% 33% 34% 39%

31% 27% 30% 34% 34%

23% 31% 28% 18% 10%

43% 36% 42% 45% 51%

42% 38% 46% 43% 39%

Total

Respondents

Millennials

(1982-1994)

Gen X

(1965-1981)

Boomers

(1946-1964)

Seniors

(1900-1945)

Figure 16: I your health plan or doctors ofce could help you look ater your health by remind-

ing you to take medicines, perorm routine sel-exams, and schedule clinical exams, how interestedwould you be in receiving the ollowing types o reminders?


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Social media

usig scial dia halth ca

appals t yg gatis;

ld gatis s it spaigly;all fd that s-gatd halth

iati via scial dia

ds additial vifcati.

26 percent o total respondents say they

used social media or health-related

purposes in the past yearuse is highest

among Millennials (40 percent) and Gen X

(29 percent) (gure 17).

Consumers primarily use social media or

learning more about a specic illness/health

problem/injury (gure 17).

As trusted sources o inormation about the

eectiveness and saety o specic treat-

ments, consumersespecially Seniors (not

shown)preer to rely on the medical com-

munity more than other sources (gure 18).

Independent health-related websites (24

percent) garner nearly as much trust as

pharmacies (27 percent) and slightly

more trust than the U.S. Food and Drug

Administration (22 percent) (gure 18).

Health plans, general Internet search

engines, bio-pharma/medical device com-

panies, employers, and social media are

least preerred as trusted sources o inor-

mation (gure 18).

Reasons or lower levels o trust in manu-

acturers include concern about ull

disclosure about products (60 percent),

a preerence to receive this type o inor-

mation rom a medical proessional (54

percent), and a belie that more objective

sources may be available (43 percent) (all

not shown).

For any health-related purposes

Generational differencesin their use of social media for

health care purposes

To learn more about specific illness/health problem/injury

To offer motivation or support to others battling an illness/injury/health problems

To learn more about prescription drugs

To comment about your own experiences using the healthcare system

Millennials

(19821994)

Gen X

(19651981)

Boomers

(19461964)

Seniors

(19001945)

17%29%40% 17%

8%12%16% 11%

6%12%14% 5%

7%8%10% 10%

3%4%8% 3%

Figure 17: In the last 12 months, have you used social me-dia (e.g., an online community support site, chat room, or

social networking site) to do any o the ollowing?


22


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Figure 18: I you wanted inormation about the most eective and sae treatment(s) or a certainhealth condition, how much trust would you have in the ollowing third-party sources to provide

reliable inormation?

Trust in sources to provide reliable inormation on most eectiveand sae treatment(s) or a certain health condition

2009 2010 2011 2012

Physician group/medical practice n/a n/a n/a 44%

Academic medical centers/teaching hospitals 50% 41% 47% 38%

Medical associations/societies 51% 45% 45% 37%

Community hospitals 31% 28% 32% 30%

Pharmacies 28% 27% 30% 27%

U.S. Department o Health and Human Services (HHS) 31% 25% 30% 26%

Independent health-related websites 28% 22% 27% 24%

U.S. Food and Drug Administration (FDA) 27% 23% 28% 22%

State Departments o Health and Human Services 28% 23% 27% 22%

Health insurance companies/health plans 13% 10% 14% 14%

Internet search engines/general reerence sites n/a n/a n/a 14%

Pharmaceutical, biotech, or medical device/product manuacturers 11% 9% 10% 12%

Employers (e.g., health benefts ofce, human resources ofce) 10% 9% 12% 12%

Blogs or websites that address specifc health issues or connect people with similar healthconditions

n/a n/a n/a 11%

Social networking sites n/a n/a n/a 5%

/a =t askd; std i dscdig d 2012 ly

ratig 8, 9 10 a 10-pit scal wh 10 is cpltly tst


23


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Zone three: Traditional

health services utilizationThe majority o consumers report accessing primary careeitheror routine check-ups or injury/illness. Use o the emergencyroom is rising but satisaction with this service is dropping.

76 percent o consumers (85 percent in

2011) say they visited a physician or other

health care proessional in the past year orsome purpose (gure 19).

65 percent visited or a routine check-up

(76 percent in 2011) and 39 percent or an

injury or illness (54 percent in 2011)

(gure 19).

Around 2 in 5 consumers say they received

care in a hospital in the last year, either

as an outpatient (23 percent), emergencypatient (19 percent), or inpatient (8 per-

cent); use o emergency care is rising (rom

13 percent in 2009 to 19 percent in 2012)

(gure 19).

*Hospital service figures for 2008 and 2009 are 1 year estimates calculated ashalf the reported 24-month rates

Percentage reporting Yes

100%

2008 2009 2010 2011 2012

40%

60%

80%

20%

0%

Doctor visit (any purpose)

Have primary care provider

Doctor visit for well/check up

Prescription medications

Doctor visit for illness/injury

Over-the-counter medications

Hospital care (all types)*

Outpatient care*

Emergency care*

Inpatient care*8%8%

13%

16%

26%

38%

53%

83%

60%

61%

82%

19%

23%

31%

39%

41%

51%

65%

76%

78%

Figure 19: Which o the ollowing have you done in the past 12 months?


24


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Hal o all consumers (51 percent) in 2012

say they currently take prescription medica-

tions: o those taking medication, 23 per-

cent take one medication, 38 percent take

two or three, and 35 percent take over ourprescription medications (not shown).

Primary care

m css a sig s

pactitis (nP) physicia

assistats (PA) piay ca.

Nearly 4 out o 5 consumers report having a

PCP (gure 20).

Satisaction with their PCP is high and ris-

ing76 percent o consumers are satised

with their PCP in 2012, compared with 73

percent in 2011, 71

percent in 2010, 72

percent in 2009, and 66

percent in 2008 (shown

in gure 23).

Among the uninsured,

the percentage having a

PCP has dropped rom

58 percent in 2008 to

46 percent in 2012

(gure 20).

O the uninsured,

reasons or not having

a PCP include being

unable to aord care

(64 percent), no insur-

ance (49 percent) or

eeling as i they dont

need a PCP (15 per-

cent) (not shown).

Poor quality o both care and service

prompt people to switch physicians and 8

percent say they switched their PCP in the

past year. O these, 25 percent say they did

so or reasons associated with the PCPsstyle/manner (such as not showing cour-

tesy or respect or not spending sufcient

time); 18 percent did so or cost reasons

(such as out-o-pocket costs or physician no

longer accepting insurance); and 17 percent

switched or access and customer-service

reasons (such as difculties in getting a

timely appointment or long wait times)

(not shown).

Consumers with a medical doctor (MD) as

a PCP have declined over the past ve years

(gure 21).

Insured

2008

49%

81%

85%86%

82%

58%

86%87% 87%

82%81%

78%

46%46%

43%

2009 2010 2011 2012

Total Uninsured

40%

50%

60%

70%

80%

90%

Figure 20: Do you currently have a doctor, nurse practitioner, physician

assistant, or other health care proessional you consider to be yourprimary care provider?


25


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*Strongly agree or agree**Rating of 8, 9, or 10 on a 10-point scale where 10 is extremely likely

27%

20%

21%

A pharmacist can provide many of thesame services that a primary care

provider offers*

Used a pharmacist for treatmentinformation or advice for self or family

member instead of seeing a doctor

(in the past year)

Asked a pharmacist for their opinionabout a medication that was prescribed

by a doctor (in the past year)

Would use a medical vending machineto fill a prescription**

14%

22%

14%

10%

6%

20%

17%

17%

22%

22%

24%

17%

11%

Millennials(19821994)

Gen X(19651981)

Boomers(19461964)

Seniors(19001945)

Figure 22: Please indicate your level o agreement with the ollowing statements / Which o the

ollowing, i any, have you experienced yoursel in the last 12 months? / How likely would you beto do the ollowing i these options were available to you?

Figure 21: What type o health care proessional do you consider to be your primary health care

provider?

2008 2012

MD 95% 87%

NP/PA 4% 10%

Other 1% 3%


26


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During the same time period, use o a nurse

practitioner (NP) or physician assistant

(PA) as a PCP has increased rom 4 percent

to 10 percent (gure 21).

13 percent say they used a pharmacist or

treatment or advice or themselves or a

amily member rather than consulting a

doctor in 2012. Millennials seek out phar-

macists more than older generations: 1 in

5 (22 percent) o Millennials (1982-1994)

say they used pharmacists in this manner

compared with 14 percent o Generation X

(1965-1981), 10 percent o Baby Boomers

(1946-1964), and 6 percent o Seniors

(1900-1945) (gure 22).

1 in 4 Millennials believes that pharmacists

could provide many primary care services

similarly to a physician (gure 22).

Pcptis availabilityad qality hspitals ad

physicias vay sbstatially by

isac stats ad sc.

Medicare enrollees perceive greater access,

better aer-hours availability, and shorter

waiting times or appointments (gure 23).

For those without insurance, access is

perceived to be substantially more difcult

than or the insured (gure 23).

Rating of 8, 9, or 10 on a 10-point scale where 10 is Completely adequate

72%

61%

58%

46%

39%

69%

58%58%

44%

37%

42%41%

48%

26%25%

64%

48%46%

38%

27%

70%

64%

59%

39%

Quality of careprovided by

doctors

Quality of careprovided by

hospitals

Availability ofplaces for care

after normalbusiness hours

Length of timeto have to wait

to get appointmentwith my primary

care doctor

Availability ofdoctors who are

likely to acceptmy insurance

Uninsured Medicaid Direct purchase Employer-sponsored Medicare

Figure 23: Thinking about what is available within a reasonable driving distance rom your home

or through public transportation, how would you rate the adequacy o the ollowing?


27


30/48

Hospital care

us gcy ca is isig;satisacti with hspital ca

(tpatit, ipatit, ad gcy

ca) is dcasig slightly, big

div by qality ad cst-

svic isss tha by cst.

2 in 5 (41 percent) say they used a hospital

service in the past year (shown in Figure

19). 65 percent o recent hospital users

(any hospital service) are satised with the

care they received (77 percent in 2011, 75percent in 2010, and 74 percent in 2009)

(not shown).

Satisaction with primary care providers is

consistently high and has increased since

2008, while satisaction with other system

elements (hospital care and health plans)

appears to be declining (gure 24).

Over time, satisaction with inpatient and

emergency hospital care appears to be

decreasing considerably (gure 24).

Among consumers who say they were

dissatised with the experiences they had in a

hospital setting, dissatisaction is driven more

by quality and services (2 out o 3 consumers)

than by cost (40 percent) (gure 25).

Retail clinics

Css a cptiv t sigtail cliics i dical

pblsthi val, cvic,

ad accss a attactiv.

14 percent o consumers report they used

a retail clinic in the past 12 months (down

rom 19 percent in 2011, but similar to 15

percent in 2010 and 13 percent in 2009)

(not shown).

Rating of 8, 9, or 10 on a 10-point scale where 10 is completely satisfied

Satisfied with outpatient hospital care (% of users)

Satisfied with inpatient hospital care (% of users)

Satisfied with primary care provider (% of those with a PCP)

Satisfied with emergency hospital care (% of users)

Satisfied with health plan (% of insured)

Satisfied with overall system performance

2009 2010 2011 2012

79%

74%

72%

68%

74%

67%

76%

55%

52%

57%

70% 70%

73%

81%

81%

71%

76%

80%

52%

24%22%

16%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Figure 24: Overall, how satisied are you.?


28


31/48

40%

41%

37%

42%

32%

16%

24%

28%

36%

39%

35%

35%

20%

26%

17%

19%

0% 20% 40% 60% 80%

ER Inpatient

Cost

Customer service

Access/availability

Coordination/follow-up

Treatment process

Style/manner

Skills/specialization

Infrastructure

2 out of 3 consumers whowere dissatisfied with

their recent hospital carecite service-related

reasons (66% ER and62% inpatient care)

2 out of 3 consumers who

were dissatisfied withtheir recent hospital care

cite quality-relatedreasons (63% ER and67% inpatient care)

Figure 25: Why are you less than completely satisfed with your most recent experi-

ence as an overnight patient/outpatient?

25 percent say they are willing to visit a

retail clinic i their physician is not available

(not shown).

Among retail clinic users:

Almost 2 out o 3 (61 percent) are satis-

ed with the care they or their amily

member received during a retail clinic

visit (not shown).

Hal choose retail clinics because o

convenience and/or speed o getting an

appointment (gure 26).

Dissatisaction with retail clinic experi-

ences relate to quality (37 percent), cost (34

percent), and an unmet need (29 percent)(not shown).


29


32/48

Prescription medicationsand over-the-counterhealth care products

Cs cfdc with pscipti

dicatis is high bt cst ccs

lad ay twad gic altativs,

as wll as t s h dis

ad v-th-ct pdcts.

Prescription drug use has declined in recent

years, including among those with chronic

conditions and among both the insured and

uninsured (gure 27).

40 percent o all consumers say they

used home remedies or over-the-counter

medicines instead o going to see a doctor/

medical proessional because it was cheaper

(not shown).

In 2012, 37 percent say they purchased

a generic drug rather than a prescribed

brand drug based on advice received at

the pharmacy counter (not shown).

Close to 9 in 10 prescription medication

users are highly condent about their

medications, saying they understand how

the medications work, understand risk and

side eects, and believe in the efcacy o the

medications (gure 28).

In 2012, 1 in 10 reports they stopped taking

their medication early or changed dose/re-

quency without speaking with their doctor

(gure 29).

Reasons for use of retail clinic for self and/or family (those who used in past year)

0%

20%

40%

60%

80%

58%

50% 50%

41%

26%

6%

Convenience:clinic location

Speed ofappointment

Access/availability

after normalbusiness hours

Cost: Visit atthe clinic cost

less than adoctors visit

Quality Other

Figure 26: Which o the ollowing actors led you to choose to go to the retail walk-in clinic?


30


33/48

% of those with chronic condition(s)

% of insured

% of total sample currently taking prescription medications

% of uninsured

2008 2009 2010 2011 2012

95%

51%

28%

57%

73%

63%

60%

41%

100%

80%

60%

40%

20%

0%

Figure 27: Are you currently taking any o the ollowing products to treat a health condition/problem

or improve your health?

Fewer prescription medication users report

switching medications than in previous

years14 percent in 2012 compared with29 percent in 2009 (gure 29).

Few consumers switch medications, but

those who do, switch in search o better

eectiveness (42 percent), ewer side eects

(30 percent), and medicines that are easier

to take (12 percent). 34 percent say they

switched to a generic to save money and 16percent say they switched or insurance-

related reasons (not shown).


31


34/48

88%

87%

86%

Understandhow Rxworks

Thosetaking Rx

Nottaking Rx

Strongly Agree or Agree

Understandrisk and

side-effects

Confident Rxis effective

49% 51%

Figure 28: Thinking about the prescription medication you are currently taking,

please indicate your level o agreement with the ollowing statements:

2009 (n = 2,295 Rx users)

Switched Rx Discontinued taking Rxbefore it was finished

Modified dosage or frequency ofRx without asking or telling doctor

2011 (n = 2,261 Rx users)

2010 (n = 2,233 Rx users)

2012 (n = 2,061 Rx users)

0%

20%

40%

Data are shown for the years that the question was included in the survey

NA 2009

29%

26%

21%

14%

10%

15%

10%

15%

11%

NA 2009 or 2010



32


35/48

Zone our: Alternative

health services1 in 10 consumers integrates alternativetherapies with traditional care.

Nearly 1 in 10 respondents in 2012 says

they treated a health problem with alter-

native treatment approaches and naturalremedies compared with around 1 in 5 who

did so during 20082011 (gure 30).

Few use alternative or natural therapies

either in substitution or or in addition to

prescription medications and use appears to

be declining over the years (gure 30).

12 percent say they preer doctors who

take an alternative/

holistic approach

to treating health

problems, down

slightly rom 15

percent in 2008.

Over the same

period, the per-

centage stating a

clear preerence or

doctors who take

a standard medi-

cal approach grew

rom 42 percent to

47 percent.

o treat minor illnesses, 17 percent say

they preer to take natural remedies like

herbal medicines rather than medicinesprescribed in standard medical care. Tis

has not changed in recent years, but is

higher among the younger generations (22

percent o Millennials, 19 percent o Gen

X) than the older generations (14 percent o

Boomers, 11 percent o Seniors), suggest-

ing use o natural remedies may increase in

coming years.

Percentage who

had done soin the past year

Treated a health problem with analternative approach or natural

therapy (e.g., acupuncture,chiropractic, homeopathic,naturopathic, bio-electric)

Used an alternative treatmentapproach or natural

therapy in addition to Rx

Substituted/used an alternativetreatment approach or

natural therapy instead of Rx

9%

18%

22%

19%

7%

13%

20%

16%

7%

8%

10%

9%

2012

2009

2010

2011

0% 5% 10% 15% 20% 25%



33


36/48

Zone Five: Health insurance

Fewer than hal the consumers are satisfed with health plansin particular, a shit rom eeling well-insured to eelingeither adequately insured or under-insured is evident.


34


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80 percent o consumers in 2012 reporthaving some kind o health insurance

through a commercial plan or government-

sponsored program (gure 31).*

Most consumers have insurance rom

employers (47 percent), through govern-

ment programs (27 percent) or purchased

directly (6 percent) (gure 31).*

Satisaction with health plans has declinedin recent years, rom 52 percent in 2009

saying they are satised to 57 percent in

2010, 52 percent in 2011, and 44 percent in2012 (shown in gure 24).

16 percent o the insured report switch-

ing health plans in 2012 (11 percent did so

in 2008, 17 percent in 2009, 20 percent in

2010, 11 percent in 2011). Many consumers

are switching plans or cost-related reasons:

47 percent o those who switched in 2012

say they did so or cost-related reasons,

including seeking to pay less, get bettervalue, or reduce out-o-pocket costs; or an

inability to aord premiums (not shown).

80%

Employer-based

insurance

Government

program

Direct purchase

20%

47%

Insured

Uninsured

27%

6%

Figure 31: Which o the ollowing best describes your health insurance status during the

past 12 months?*

* Qtas w sd t s that th isac stats ad sc distibtis sapl atch ths bsvd ith u.S. adlt pplati. Plas s th thdlgy scti iati.


35


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Coverage-related reasons or switching

insurance, such as seeking better coverage

or accessing dierent benets or providers,

also appear to be increasing, rising rom 22

percent among reasons or switching plans

in 2009 to 29 percent in 2012 (not shown).

Te number o those eeling well-covered

has declined with sentiment shiing to

eeling adequately or under-insured

(gure 32).

Tose eeling under-insured grew between

2011 and 2012 (8 percent to 14 percent)

(gure 32).

2 o 3 consumers who are uninsured have

been without health insurance or at least

12 months. 1 in 5 has been without insur-

ance or part o the past year (gure 33).

Cost (61 percent), changing or losing

employment (26 percent), and employer

not oering insurance (19 percent) are key

reasons or not currently having insurance

(not shown).

51%

39%

8%

2% 2%1%

2%

14%

26%

59%

8%

35%

56%

9%

39%

50%

2009

Well insuredAdequately insured Under-insured Not sure

2010 2011 2012

40%

60%

20%

0%

Figure 32: Thinking about the amount and types o health insurance coverage you currently have, do you

consider yoursel to be?


36


39/48

Figure 33: Which o the ollowing best describes your health insurance status during the

past 12 months?

O all consumers O uninsured consumers

Uninsured 20% 100%

Uninsured or all o past 12 months 13% 68%

Uninsured, but had insurance or parto last 12 months

4% 23%

Uninsured , but not sure about statusor past 12 months

2% 9%

Data a dd

Consumers want choiceand customization whenpurchasing health insurance.

may css a itstd i takig

a activ l wh slctig ad

pchasig thi halth ca cvag.

Yg gatis, i paticla, shw

itst i cstizig plas ad havig

a chic pla styls ad ptis.

Only 6 percent currently have insurance

that they bought directly; however, 33 per-

cent say they would preer to obtain insur-

ance that way (gures 34 and 35).

Consumers show some interest in alterna-

tive ways o obtaining insurance: interest

is split between a preerence or person-

ally shopping or insurance and or taking

advantage o employer oerings (gure 35).

I given the choice, close to 3 in 5 consum-

ers say they would preer to customize their

health plan rather than select rom pre-

dened options (gure 36).

Interest in customizing is highest among

the youngest generations: 64 percent o

Millennials and 62 percent o Gen X say

they are interested, whereas 41 percent o

Seniors say they are interested (gure 36).


37


40/48

Direct purchase frominsurance company

or through exchange,connector, or website

6%

27%Government

program

47%Employer-

based

20%Uninsured

33%Shop onmy own

(through onlinesources or exchanges,

brokers, or directcontact with

insurers)

3%Do not wish toobtain a healthplan under anycircumstances

4%Some otherapproach

32%Select from

options offeredby an employer

17%Select from

options throughgovernment

programs

12%No opinion/preference

Figure 34: Thinking about your primary health

insurance coverage (meaning the health insur-ance policy/health plan that currently provides

the most coverage or medical care), how did

you get this coverage?

Figure 35: There are many potential ways toobtain a health plan. I you were given the

choice, which approach would you preer?

TotalRespondents

Millennials(19821994)

Gen X(19651981)

Boomers(19461964)

Seniors(19001945)

Do not want a plan underany circumstances

Pre-defined plan wherebenefits, features, and

associated costs havebeen set

Customized plan where youcan select benefits andfeatures from a menu ofoptions knowing the costwill reflect what you choose

No opinion/preference

Some other kind of plan

5%

15%

5%

34%

41%

3%

13%

6%

24%

54%

3%

9%

4%

21%

62%

2%

8%

5%

21%

64%

3%

11%

5%

24%

57%

Figure 36: There are dierent ways to design a health plan such as the mix o benefts, eatures, and

costs that might make up a particular health plan. I you were given the choice, which kind o healthplan would you preer?


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Zone six: Health policy

views on health care reormA good start or a step in the wrong direction?

Overall, consumer support or health care

reorm slipped rom 2011: hal elt posi-

tively about health care reorm in 2011 (49percent) versus 38 percent in 2012 (gure

37). Te strongest positive inclinations

about the health care reorm law are held by

the Millennial generation (1982-1994) (41

percent in 2012).

Uncertainty about reorm increased, with

34 percent in 2012 either not knowing or

expressing no opinion versus 21 percent in2011 (gure 37).

Seniors are more negative about reorm

than others: the percentage o consumers

o all generations thinking that health care

Figure 37: Based on what you know or have heard about the health care reorm law, is it a good

start or a step in the wrong direction?

2011 2012 change 2011 2012 change 2011 2012 change

Total 49% 38% 30% 29% 21% 34%

Male 50% 39% 33% 32% 18% 29%

Female 50% 36% 26% 26% 24% 38%

Millennials(1982-1994)

55% 41% 22% 20% 24% 39%

Generation X(1965-1981)

49% 37% 28% 27% 23% 36%

Baby Boomers(1946-1964)

49% 36% 34% 32% 17% 32%

Seniors(1900-1945)

46% 36% 35% 38% 20% 26%

Insured 49% 38% 31% 30% 21% 32%

Uninsured 55% 37% 24% 23% 22% 40%

nt: Figs a dd ad ay t ttal t 100%

gd stat stp i th wg dicti Dt kw/ctai


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reorm is a step in the wrong direction

has remained relatively constant; however,

positive views o reorm have declined sub-

stantially in all generational groups, shiing

toward dont know/no opinion.

What might be achievedby health care reorm?

Css a cla abt th likly

slts th Adabl Ca Act (ACA):

th ajity is t s it will icas

accss, dc csts, ipv qality.

Views o health care reorms likely suc-

cess in achieving its stated goals are mixed.

Around one-ourth (27 percent) o con-

sumers eel that health care reorm will suc-

cessully increase access to health insurance

coverage and around one-h (20 percent)

believe that reorm is likely to be successulin increasing the quality o care, motivating

individuals to improve their health (20 per-

cent), better coordinating care (20 percent),

and ensuring access to the latest technolo-

gies (21 percent) (gure 38).

Only 16 percent eel that health reorm will

successully decrease health care costs over-

all, with 32 percent believing the contrary

(gure 38).

Figure 38: Based on what you know or have heard about the health reorm law, how successul is

the health reorm law likely to be at accomplishing the ollowing?

Consumer Survey (2012)Top 3 (8, 9, 10) where

10 is completelysuccessul

Bottom 3 (1, 2, 3)where 1 is not at

all successul

Increasing access to health insurancecoverage

27% 20%

Increasing use o the most up-to-dateinormation technology (IT) in hospitals anddoctors' ofces

21% 20%

Increasing quality o health care overall 20% 26%

Motivating and supporting people to

improve their health

20% 24%

Health care proessionals and organizations,such as hospitals, working together to bettermanage care or patients

20% 22%

Ensuring access to the latest and newestinnovations in treatment, services, andmedical technology

18% 22%

Decreasing health care costs overall 16% 32%


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Key fndingsThe six major takeaways are:

1. Evident over the ve years o this study, U.S.

consumers recognize that the health care

system is costly, conusing, and is perceived

to deliver suboptimal service and value.

2. Most consumers have a touch point with

the health care system through their pri-

mary care practitioner, and satisaction with

this service is high. Consumers increasingly

are open to primary care being delivered by

a range o proessionals including physi-

cians, nurse practitioners, physician assis-

tants, and pharmacistsand see potential

or primary care to lower costs and improvequality o the health care system overall.

3. Consumer condence in dealing with

uture health care costs is declininganxi-

ety and concern about uture health care

costs are prevalent. Te cost o care coupled

with the unavorable economic conditions

o the past ew years are prompting con-

sumers to scale back out-o-pocket spend-

ing, delay or skip care, and consider

using non-conventional options.

4. A solid base o e-health

consumers is slowly grow-

ing: over the past ew

years, comparatively low

numbers o consum-

ers have turned to online

resources or health care

when compared with use o

online resources in other

industries. Generational dierences in the

use o technology or health care purposes

are critical insights: the younger, healthy

generations are the most interested andopen to using technology but have the least

need to do so. However, with the passage

o time, utilization o health care by these

groups will increaseeither or themselves

or as carers or amily members and this

group will expect smart-tools, ready access,

and immediacy with respect to health care

inormation and communications with

providers and insurers.

5. Insurance is key to accessing the system,

with disparities between those with and

those without insurance clearly evident

over the past ve years. Insured consum-

ers eelings o being adequately covered

are declining.

6. Despite the act that about hal o consum-

ers recognize that unhealthy liestyles are

a substantial cost driver o the system, a

low level o engagement is evident

in consumers pursuit o healthy

behaviors, use o preventive

care, and health maintenance

activities. Te reasons or this

are unclearthey may be

due, in part, to consumers

cost-sensitivities but this

highlights the need or a

greater ocus on wellness

in the system.


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How best can stakeholders (particu-

larly health plans, medical device and

bio-pharma companies, and health care

providers) optimize the customer experi-

ence? Eective customer-service strategies,

including the relentless pursuit o quality,

patient saety, and care coordination, will

be required. Also, new and/or additional

resources and structures will be needed to

provide consumers with advice and inor-

mation to help them successully navigate

the system and better manage/coordinatetheir health. In addition, drug and device

manuacturers will need to increasingly

consider their end users when positioning

their value proposition.

An engaged health care consumer is

central to successul strategies to

re-ocus the current health care

system. What carrots and

sticks are necessary tomotivate and incentivize

consumers to manage

their own health, and

how can stakeholder

organizations (provid-

ers, health plans, bio-

pharma companies) devise and

implement eective consumer engagement

strategies? What tools and systems need to

be in place to encourage consumer engage-ment? What part do new technologies such

as distance medicine and telemedicine, sel-

care, bio-monitoring, and physician e-visits,

as well as allied health clinics and other

ambulatory acilities, play in achieving this?

Commercial health insurance companies

will need to consider how best to structure

products and shopping experiences or

consumers who have been without health

insurance. An inux o newly insured will

require business models that reinorce the

need or real-time integration o clinical

and claims data or better decision-making;

payment systems that align with outcomes;

a ocus on enhanced clinical eectiveness;

inormation and decision-support tools;

consumer-oriented inormation, account-

ability, and incentives that align with care

goals; integration o care pathways; and

the use o tools and technologies such as

monitoring devices.

Multi-channel inormation strategies will

be necessary to reach consumers in a mar-

ketplace that is ragmented with multiple

opportunities, resources, and inorma-

tion streams or consumers to use to

access inormation and

acilitate decision-making

about the health care they

consume. Dierent mediapreerences and utiliza-

tion behaviors are evident

among generational age

groups; services and chan-

nels should, thereore, be tar-

geted to take these dierences into

account. Emerging media ormats,

tools, and apps oer consumersparticu-

larly younger generational groupsconsid-

erable opportunities to use online resourcesand social media or motivation and health

goal tracking, wellness, inormation gather-

ing, support, and encouragement.

Health care providers may need to posi-

tion their core services, customer service

strategies, and communications tools

and techniques to take advantage o the

myriad consumer-oriented, technologically

based health care tools. Providers need to

Stakeholders in the U.S. health care system should considerthe ollowing implications, issues, and challenges:


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meet the challenge o providing real-time,

understandable health inormation, test

results, and other relevant data or consum-

ers in easy-to-access ormats. Not every one

has, or wants, a smartphone or tabletnor

is all health care inormation suitable or

such platormsso, what are the solutions

going orward?

Providers, regulators, and insurers should

be alert to the changing landscape o pro-

viding health careparticularly primary

care. New non-traditional sites/service

models that oer high-quality care, con-

venience, access, and aordability provide

opportunities to capitalize on consumer

interest. Tese new service delivery models

will draw upon dierent skills and compe-

tencies, as well as changing incentives in

payment systems and increasing consumer

demand or health care services, and will

require a new and dierent mix in the

skilled health care workorce.


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Closing thoughts

To U.S. consumers, health care is intenselypersonalopinions about the systems per-ormance are based on individual, oen local,

sometimes painul and rustrating experiences.

Nonetheless, there is considerable opportu-nity to engage consumers more eectively in

decisions about their health and the care they

utilize. For consumers, a less expensive and less

complicated health care system, better coor-

dinated services, improved delivery models

(such as team-based care), and increased value

are imperative.

For many industry stakeholders, consum-

erism in health care is problematic. Although

inevitable, it is disruptive to standard oper-ating procedurein some cases, requiring

a massive overhaul o business models and

personnel. Deloitte believes this transorma-

tion is necessary and worth it.

As the health care marketplace moves

toward one that is grounded in value-based

competition, innovation, and consumerengagement, what has the industry learned

about how consumers view their health and

the health care system? More critically, what

more do stakeholders need to know about

health care consumers behaviors, expectations,

and unmet needs? How best can consumers

be reached? Te challenge posed by decoding

health care consumerism is to grasp where

the end recipient ts into the new normal o

health care and to identiy what opportunitiesmay be around the corner when consumer-

ism is translated into a high-perorming,

consumer-centered system o care.


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We would also like to thank Laura Eselius, Leslie Korenda, Elizabeth Stanley, Jennier Bohn,

Katrina Drake Hudson, Claire Boozer and the many others who contributed to the preparation o

this report.

Pal H. Kckly, PhDExecutive Director

Deloitte Center or Health Solutions

Deloitte LLP

[email protected]

Ctact iati

o learn more about the Deloitte Center or Health Solutions, its projects and events, please visit

www.deloitte.com/centerorhealthsolutions.

Dlitt Ct Halth Sltis

1001 G Street N.W.

Suite 1200

Washington, DC 20001

Phone 202-220-2177

Fax 202-220-2178

oll ree 888-233-6169

Email [email protected]

Web www.deloitte.com/centerorhealthsolutions

Companion reports to the Deloitte 2012 Survey o U.S. Health Care Consumers: Five Year Look

Back include an INFOBries series that presents key ndings about consumers and health inorma-

tion technology, social media and online resources; utilization o health care services; lie sciences

products and innovations; consumers and health plans. An additional report on health care con-

sumer segments is also available.

For more inormation and additional reports, visit www.deloitte.com/centerorhealthsolutions

Acknowledgements

Contacts

Shyl Cghli, PhD, mHAHead o Research

Deloitte Center or Health Solutions

Deloitte LLP

[email protected]



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